Doctors, Insurance, and Surgery Oh My: Hysteroscopy & Laparoscopy Done!

The past 5 days have been a whirlwind of doctors, nurses, surgery coordinators, and insurance companies. In my last post, I talked about how excited we were to FINALLY obtain insurance coverage for a hysteroscopy. This procedure would enable our RE to look for uterine polyps (possibly causing implantation issues) as well as to correct the uterine septum I was born with (possibly causing miscarriage/infertility issues). The hysteroscopy box has been left unchecked this whole time, but we've felt increasing urgency to do it lately, especially since we have now had 3 failed IVF transfers and have only two remaining embryos left on ice.

So, here I was....all scheduled for Friday's hysteroscopy. No big deal really. Then, I get a call from my RE asking how I would feel about adding a laparoscopy to my surgery. As many of you might know, the laparoscopy is another box many people like to check BEFORE they jump into more invasive fertility treatments. This procedure is more invasive and requires much more recovery than the hysteroscopy, but it allows the RE to get a complete view of the abdominal and pelvic organs and is used to diagnose and treat endometriosis, fibroids, cysts, and scar tissue. In fact, this is the ONLY procedure that allows for the diagnosis and treatment of endometriosis. Research has shown that even small amounts of endometriosis can result in infertility, and even IVF failure. Many times, hysteroscopy and laparoscopy will be performed simultaneously since they address different things related to infertility. 

Now, keep in mind we were presented with the option of doing laparoscopy way back when, after we hadn't had success with Clomid & Femara alone and were considering moving onto IUI or IVF. At that time however, we were told we were NOT covered for laparoscopy and that it would be a $12,000 surgery. We were given the choice of doing this very expensive surgery that might not find or solve anything, OR we could roll the dice with IUI or IVF. It was up to us. We made the decision to skip the surgery, mostly because we had zero insurance coverage for it. If it were FREE, you bet I would have chosen to do it a long time ago.

My RE is not the type of doctor that goes cutting into anyone unnecessarily either, and so he agreed with our decision to pursue IUI and IVF without ever having the laparoscopy done. He is also somewhat conservative and tries to get his patients pregnant with the least invasive means possible first.  A lot of his patients end up getting pregnant with pills, IUI, or IVF and never have to go through any surgical procedures whatsoever. Those people are very fortunate! Not to say that going through IVF is easy at all, but being able to skip any additional diagnostic surgeries and become pregnant is a bonus.

However, when you are like me...someone who has had fertility treatments for 26 months, 3 pregnancy losses, and 3 IVF transfers, still with no viable pregnancy, you find yourself going back to square one and asking yourself what's being missed....if you should bite the bullet and just have the surgeries to check things out for real, once and for all. I have never had anyone go in with a camera and actually look to see what's going on in there...nothing past two HSG's. As the IVF failures add up, it's begun to feel like we're throwing embryos into the vast unknown. 

Really, the only thing that's ever held us back from doing the lap was the cost of this darn surgery. Well, low and behold, all of a sudden for reasons unbenownst to me, I'm told we are now MAGICALLY covered for both the hysteroscopy and laparoscopy procedures under certain "medical coding" for my uterine septum?!?! I am trying not to get my panties in a giant wad over the lackluster timeliness of this miraculous occurrence and just focus on the fact that we have people working extra hard on our behalf to get something, ANYTHING covered with zero fertility or diagnostic coverage NOW....even if they didn't seem to work quite as creatively on our behalf before. I can't change the past, so I'm just trying to be grateful we are obtaining the coverage now.

We double and triple checked this week that both of these procedures would be covered under the medical coding being used. We even had our RE's surgery coordinator conference us into her phone call as she obtained benefits approval from our insurance company and recorded the entire conversation on mp3. Insurance companies rule the world, and you can never be too careful! I will believe it when I see the claim go through ultimately, but it looks like we were able to obtain coverage for $15,000 worth of surgeries for a mere $20 copay. So, my response to my RE was "Let's do this!"

Both laparoscopy and hysteroscopy were performed yesterday. Here are the findings (from what I remember/understand):

-uterine septum was excised...GONE!
-cyst found "all twisted up" into my left fallopian tube was removed
-scar tissue found on supporting ligament/entry into uterus (?) removed
-scar tissue found on liver removed
-NO endometriosis
-NO polyps

I'm told that if I wasn't already experiencing pain from the cyst on my fallopian tube, that it would have caused issues in the future, and it's good that it was removed. I have complained before of stabbing pains in the left fallopian tube/ovary area before, and very pronounced with both of my last pregnancies during the time when implantation would have been occurring. That is also the side where my suspected ectopic pregnancy occurred. Very interesting indeed.

Not sure where exactly the scar tissue was on this uterine ligament/structure/thingy, or what it could have affected...will have to gain a better understanding of this at my follow-up apt. I am beyond thrilled that there was no endometriosis or polyps. In a way I'm sure my RE could easily say, "See I told you so...didn't think you had either of these things present." On the other hand, at least now I know. I mean, how do you know until you check!? Most of all, I'm glad the uterine septum is gone, because that definitely could have been causing issue and also present issue with any future pregnancies.

So far, recovery has not been fun. The procedures took two hours. I had a few things cut out of there, and I'm definitely feeling sore and heavy and uncomfortable. There were three incisions made in my pelvic area, and there is still a balloon inside of me that won't be removed until two weeks from now at my follow-up appointment. It feels kind of similar to the day following an IVF retrieval...like you're walking around with a huge bag of marbles inside your abdomen, except more painful. I can't sit in a chair, but I can stand up and lie flat. I'm basically just rolling in and out of bed like I'm half paralyzed to pee and then go right back to watching tv and sleeping. We may not be able to try our last FET until November due to recovery time. However, I haven't had any nausea, and for that I'm thankful. So far so good in the whole scheme of things and no regrets; I have been through worse before (thyroid surgery) and I will get through this too.

With any surgery there are risks. There are people who have had horrible recovery experiences with laparoscopy and wish they'd never done it. Then there are others who've had easy recovery or found things that impacted their fertility, so it was worth it. There are also plenty of stories of those who became pregnant following this procedure as well. Everyone is different, but we are really happy we found a way to take a closer look inside finally. Things were found and taken care of during the procedures, and now I know once and for all if polyps or endo are playing a role.

If our final FET doesn't take, we feel we have a better picture of what we're actually dealing with and which forms of treatment are still feasible. We may not have $$ to keep doing IVF an endless amount of times, so we are thankful to have this broader picture of what's truly going on and what we have to work with going forward.